The Role of Sentinel Node Biopsy in the Era of Adjuvant Therapy for Melanoma

Gabriella Brancaccio; Giulia Briatico; Camila Scharf; Giuseppe Colella; Giovanni Docimo; Ludovico Docimo; Mario Faenza; Francesco Iovino; Salvatore Tolone; Pasquale Verolino; Stefania Napolitano; Teresa Troiani; Andrea Ronchi; Renato Franco; Giuseppe Argenziano

doi:10.5826/dpc.1401a38

The Role of Sentinel Node Biopsy in the Era of Adjuvant Therapy for Melanoma

Authors

Gabriella Brancaccio Dermatology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
Giulia Briatico Dermatology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
Camila Scharf Dermatology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
Giuseppe Colella Multidisciplinary Department of Medical, Surgical and Dental Specialties, Oral and Maxillofacial Surgery Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
Giovanni Docimo Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
Ludovico Docimo Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
Mario Faenza Multidisciplinary Department of Medical, Surgical and Dental Sciences, Plastic Surgery Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
Francesco Iovino Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
Salvatore Tolone Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
Pasquale Verolino Unit of Plastic Surgery, Multidisciplinary Department of Medical Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli"
Stefania Napolitano Department of Precision Medicine, Medical Oncology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
Teresa Troiani Department of Precision Medicine, Medical Oncology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
Andrea Ronchi Division of Pathology, Department of Mental Health and Preventive Medicine, “Luigi Vanvitelli” University of Campania, Naples, Italy
Renato Franco Division of Pathology, Department of Mental Health and Preventive Medicine, “Luigi Vanvitelli” University of Campania, Naples, Italy
Giuseppe Argenziano Dermatology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy https://orcid.org/0000-0003-1413-8214

Keywords:

melanoma, adjuvant therapy, sentinel node biopsy

Abstract

Sentinel lymph node biopsy (SLNB) is a surgical procedure aimed to detect nodal metastases in patients with clinically occult disease. Since the advent of new systemic therapies, its role in melanoma has been extensively debated over the last years. In this article, three possible scenarios are discussed, considering the SLNB impact on the management of melanoma patients. First, pT1b and pT2a patients with negative SLNB (stages IA and IB) and those with positive SLNB (stage IIIA) would all not benefit from adjuvant treatment. Therefore, SLNB might be avoided in these categories of patients. Second, in IIB and IIC, melanoma patients are already candidates for adjuvant treatment; therefore, SLNB in patients with T3b, T4a, or T4b melanoma would not change treatment decisions. On the other end of the spectrum, patients with pT2b and pT3a melanomas (clinical stage IIA) represent the only two groups whose management would be significantly affected by the SLNB status, being adjuvant therapy only indicated for SLN-positive patients. Further studies are needed to investigate which melanoma patient deserves SLNB.

References

Morton D. Overview and update of the phase III Multicenter Selective Lymphadenectomy Trials (MSLT-I and MSLT-II) in melanoma. Clin Exp Metastasis. 2012;29(7):699–706. DOI: 10.1007/s10585-012-9503-3. PMID: 22729520. PMCID: PMC3463679.

Faries MB, Thompson JF, Cochran AJ, et al. Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma. N Engl J Med. 2017;376(23):2211–2222. DOI: 10.1056/NEJMoa1613210. PMID: 28591523. PMCID: PMC5548388.

Wong SL, Faries MB, Kennedy EB, et al. Sentinel lymph node biopsy and management of regional lymph nodes in Melanoma: American society of clinical oncology and society of surgical oncology clinical practice guideline update. J Clin Oncol. 2018;36(4):399–413. DOI: 10.1200/JCO.2017.75.7724. PMID: 29232171.

Morton DL, Cochran AJ, Thompson JF, et al. Sentinel node biopsy for early-stage melanoma: Accuracy and morbidity in MSLT-I, an international multicenter trial. Ann Surg. 2005;242(3):302-311; DOI: 10.1097/01.sla.0000181092.50141.fa. PMID: 16135917. PMCID: PMC1357739.

National Comprehensive Cancer Network. Melanoma : Cutaneous (Version 1.2023) [Internet]. 2023. Available from: https://www.nccn.org/professionals/physician_gls/pdf/cutaneous_melanoma.pdf PLEASE PROVIDE DATE OF ACCESS

Garbe C, Amaral T, Peris K, et al. European consensus-based interdisciplinary guideline for melanoma. Part 2: Treatment - Update 2022. Eur J Cancer. 2022;170:256–284. DOI: 10.1016/j.ejca.2022.04.018. Epub 2022 May 24. PMID: 35623961.

Nieweg OE. False-negative sentinel node biopsy: Editorial. Ann Surg Oncol. 2009;16(8):2089–2091. DOI: 10.1245/s10434-009-0540-3. Epub 2009 Jun 12. PMID: 19521734; PMCID: PMC2711910.

Weber J, Mandala M, Del Vecchio M, et al. Adjuvant Nivolumab versus Ipilimumab in Resected Stage III or IV Melanoma. N Engl J Med. 2017;377(19):1824–1835. DOI: 10.1056/NEJMoa1709030. PMID: 28891423.

Eggermont AMM, Blank CU, Mandala M, et al. Adjuvant Pembrolizumab versus Placebo in Resected Stage III Melanoma. N Engl J Med. 2018;378(19):1789–1801. DOI: 10.1056/NEJMoa1802357. Epub 2018 Apr 15. PMID: 29658430.

Long G V, Hauschild A, Santinami M, et al. Adjuvant Dabrafenib plus Trametinib in Stage III BRAF -Mutated Melanoma . N Engl J Med. 2017;377(19):1813–1823. DOI: 10.1056/NEJMoa1708539. PMID: 28891408.

Napolitano S, Brancaccio G, Argenziano G, et al. It is finally time for adjuvant therapy in melanoma. Cancer Treat Rev. 2018;69:101-111. DOI: 10.1016/j.ctrv.2018.06.003. PMID: 29957365.

Brancaccio G, Napolitano S, Troiani T, et al. Eighth American Joint Committee on Cancer (AJCC) melanoma classification: what about stage IIC? Br J Dermatol. 2018;179(6):1422-1423. DOI: 10.1111/bjd.17145. PMID: 30187449.

Long G V, Luke JJ, Khattak MA, et al. Pembrolizumab versus placebo as adjuvant therapy in resected stage IIB or IIC melanoma (KEYNOTE-716): distant metastasis-free survival results of a multicentre, double-blind, randomised, phase 3 trial. Lancet Oncol. 2022;23(11):1378–1388. DOI: 10.1016/S1470-2045(22)00559-9. PMID: 36265502.

Wilson M, Geskin LJ, Carvajal RD, et al. Adjuvant nivolumab in high-risk stage IIb/IIc melanoma patients: Results from investigator initiated clinical trial. J Clin Oncol. 2021;suppl.9583. DOI: 10.1200/JCO.2021.39.15_

Hindié E. Adjuvant therapy in stage IIB and IIC melanoma: is sentinel biopsy needed? Lancet. 2022;400(10352):559. DOI: 10.1016/S0140-6736(22)01388-5. PMID: 35988562.

Amin MB, Edge SB, Greene FL, et al. American Joint Committee on Cancer (AJCC). AJCC Cancer Staging Manual. 2017.

Gershenwald JE, Scolyer RA, Hess KR, et al. Melanoma staging: Evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017;67(6):472–492. G DOI: 10.3322/caac.21409. PMID: 29028110. PMCID: PMC5978683.

Brancaccio G, Pellerone S, Scharf C, et al. Sentinel node biopsy in thin melanoma: a retrospective descriptive cohort study. J Eur Acad Dermatol Venereol. 2022;36(10):e795-e796. DOI: 10.1111/jdv.18274. PMID: 35622455.

Moncrieff MD, Lo SN, Scolyer RA, et al. Evaluation of the Indications for Sentinel Node Biopsy in Early-Stage Melanoma with the Advent of Adjuvant Systemic Therapy: An International, Multicenter Study. Ann Surg Oncol. 2022;29(9):5937–5945. DOI: 10.1245/s10434-022-11761-4. PMID: 35562521; PMCID: PMC9356930.

Moncrieff MD, Lo SN, Scolyer RA, et al. Clinical Outcomes and Risk Stratification of Early-Stage Melanoma Micrometastases From an International Multicenter Study: Implications for the Management of American Joint Committee on Cancer IIIA Disease. J Clin Oncol. 2022;40(34):3940-3951. DOI: 10.1200/JCO.21.02488. PMID: 35849790.

Hindié E. Adjuvant therapy in stage IIIA melanoma. Lancet Oncol. 2021;22(7):e299. DOI: 10.1016/S1470-2045(21)00346-6. PMID: 34197759.

Eggermont AMM, Suciu S, Robert C. Adjuvant therapy in stage IIIA melanoma - Authors’ reply. Lancet Oncol. 2021;22(7):e300. DOI: 10.1016/S1470-2045(21)00354-5. PMID: 34197760.

Michielin O, van Akkooi A, Lorigan P, et al. ESMO consensus conference recommendations on the management of locoregional melanoma: under the auspices of the ESMO Guidelines Committee. Ann Oncol. 2020;31(11):1449-1461. DOI: 10.1016/j.annonc.2020.07.005. PMID: 32763452.